| NPI | 1053497206 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: CT 7234) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MA 1181) |
| 1041C0700X Social Worker Clinical (Licence: MA 111795) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: MA MS1125839N) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2019-05-29 |